skilled CRNA

How can I help?

I think some are confused at this point.  I think some of you truly think I'm a recruiter for BlocHealth or National Anesthesia or some other company.  Some think that I'm some fancy dude that is just rolling in bank.  I hate to tell you that this is just so far from the truth.  

I'm a CRNA.  I've been a CRNA since December, 2009.  I have made my way through the locums world since 2011 and have been relatively happy.  I share my experiences and what I've learned along the way.  Yes, I've learned the hard way because honestly half the most out-spoken people just don't know everything and if they say they do... ask yourself if you know everything after being a XYZ of 10-20-30 years.... I'm betting the answer is no.  I prefer to state that I'm no lawyer or accountant but this is my experience, as it's the truth.  I'm not a financial expert or licensed as such so to give counsel... I can't do that.  I can tell you the things I have done or the people I have talked to.  

I can tell you what has and hasn't worked for me.  That's what this site is about, educating you so you don't make the same mistakes I have or collectively understanding where we are and where we go from here.  Giving you options and helping you to be able to figure out decent people to work with.  I can't tell you they are all perfect because part of the information is gathered from our peers to make this a more wholistic site.  I'm trying to give you all the information and not just one perspective.  

So, I'm not a recruiter because I don't call hospitals and get contracts for work.  I don't place CRNAs with hospitals or groups. I ask people to say that I referred them to all the agencies (when this site is instrumental in doing so) when they are going to go the agency route as the referral helps me make this site stronger for you and helps support the number of hours put into this resource. 

How many have looked at the other links at the bottom of the main page?  Anyone see the Store, Financial information that has Accountants and Financial advisers, Mortgage information, and maybe even the Where we go page that has the article by one of our own on RV'ing it across the country?  Take a moment to see all there is to offer.  Jobs come and go from the job board too.  

Any time I discuss with someone I try to make sure I ask.. How can I make this better?  What would help you more?  So, I'll leave you with my E-mail  

I did get a request from an undergrad resource wanting to place links to anesthesia schools and feel that first one has to be done with school and should get their practice down before considering locums... so unfortunately, I declined that request.  I'm trying to keep this a clean but solid resource.  so... How can I help?


it’s always interesting going new places.  I love it.  I have fun and treat people as if I’ve known them for years.  I have fun at work while getting the serious things done in a quick and efficient manner.  I believe that this relaxes the crew and the patient.  I always state that I’m not new to anesthesia but am new to the facility and why I’m going through the paperwork a little more. 

I expect to be checked on a little more or observed more closely if in a “Care team”  model.  CRNA group the same happens just because they don’t know me or what I do/don’t know.  It’s just how things go.  I also expect them to vary the assignments from big to little to tiny and see how they wish to utilize my skill-set... it’s a way of interviewing me.  They see if I complain or fumble or have issue with those that have the most awesome personality.  These things are part of the locum political environment. I generally say that I stay out of the politics by being a locum.  I should have been saying that I remain outside of the political arena that most ACT CRNAs are in.  It’s not that it doesn’t exist ... it’s just significantly less than full-time staff typically experience.  

I have some docs and CRNAs that try to teach me at times ... from how I should hold my Miller to doing a CVP fall whenever doing a central line.  I’m not above learning and I’ll simply nod or oblige if they want something simple that’ll re-assure them that my intervention is done safely and efficiently.   

I guess what I’m saying is that each place I go I expect a period of assessment in some way.  I expect to be thrown in to the mix quickly and handed around to the different personalities and surgeons.  I always listen too.  When I hear “oh, they put him there...” I know it’ll be an interesting day.  I think we, as locum providers, need to know whom the client is, how to handle interpersonal communications, and have to be more knowledgeable in a broader scope of practice than most institutions utilize.   

I think it takes about 4-6 weeks for a place to get used to a new provider whether it be locum or permanent... then 5-9 months to understand how a place operates and if they are a good provider fit.

These are just my thoughts on the day. 


Let's talk skill set.

A recent question was posed about skills and the fact that some of us get rusty or haven't done XYZ in a ... while.  What do you say? How do you talk about them?  Let's use pediatrics as the skill in question.

First, have you just not done any kiddos 0-18 in years and you want to start doing them again?? Maybe the case is you want nothing to do with kids but over 12 is ok?  Where does your comfort level sit?  

When you talk to agencies you should know they want to be realistic with where you are and where you are willing to go.  Are you willing to do pediatric cases but want a hand in the room until you are comfortable??? The first 5 - 10 cases or maybe you say I'm not comfortable and don't want to go a place I'll have to do pediatric hearts or solo pediatric ER intubations.  

This is all ok.  But, you have to realize each case type you can't do or won't do may limit your opportunities.  It totally may have zero effect.  My current hospital will put you where you are comfortable.  No blocks, heads, hearts, cvl's, art lines, peds... it's ok.   

Important! Don't tell them you do and you can't do!  You should get a credentialing packet that will ask your comfort with procedures, cases, and numbers (estimated) per year.   

Please, let your agency know where you are and be optimistic about what you do and what your willing to learn.   

Continue to show your education, CEU's, ask questions, and when you are at your assignment take initiative.  Ask questions, act interested, & be ready for opportunities. 



1st weeks

The first days in a new place are the hardest as one doesn't know the Doctors, CRNAs, Surgeons, Techs or admin.  

I had a lot of fun getting to do a variety of cases.  I'm hopeful that in the coming weeks I will have even more fun with the group here.  I have gotten back into hearts after at least a year or two off from them.  The surgeon is pretty nice and relaxed.  I've had a good group of people to work with and I truly look forward to the days to come. 

 I'm supposed to be going to multiple hospitals so next week will start a whole new day 1 process and a getting used to the system at a new hospital.  I'm excited to see this group and how they work together.  

It's interesting dynamics hearing what people do and don't like and how they express themselves.  It's not difficult to read people and see that they have reservations or dislike or like what they do.  

I have not seen it all and done it all.  I had a new experience of a doc on group text stating their displeasure with a call schedule and they will resign next week if it isn't changed.  It's just a whole new experience.  

I get a little perspective into other facets of anesthesia and management as I continue to work with people through this site, these facilities, and continually keep in contact with others.  The interesting thing is that it boils down to .. "just business".  What we do on a daily basis is truly the personal touch and a true people profession.  Please don't let me detract from that but the where we do, how we do, and when we do ... those things come down to business.  Some politics in how much hands are tied and what has to be done and how.  The thing is that business drives those decisions.  

When a new anesthesia management group takes over.  It's not because one was liked more or less or even that a group did a sub-par job.  It comes down to the buck.  Places get comfortable and complacent and happen to think they won't be taken over by another but they also have to realize that the board for the hospital, anesthesia group, surgical center, or whatever company ... may not be in the same profession.  They may have an MD/MBA and have never practiced medicine.  They may not have either a MD or MBA title.  The owner of a company may still outvote a board of directors that is supposed to be running the company.  All this is said to remind you that a contract is a contract and all have a term to them.  When things change it is business.  It is not because of the individual or that something happened.  

So, one week down and the business of anesthesia shows as a new group has merged with these hospitals and it seems to be eggshells for some.   I try to be mindful of the stress and go in happy and excited to be here.  There are things that help and happy patients are very important as the surgeons, anesthesia, and all parts of the group are more easy going and perceive a positive experience.  So ... the 1st week has to be a good week :)

Journey forward with me as we go :)


Hi guys,

It’s another beautiful day.  We are going to talk about presence.  There are a lot of things that go into this.  We have to really think about this.  In this I would say that perception also plays a key role.

As a locum, key people have to know your presence during the day.  They have to see you working.  They have to see you available and hear that you are ready willing and able to work.  You can’t say yeah in 20 minutes after my break, at least not every time.  By that I mean, if they ask you to break in half every day and every second you get a 15 minute break or your lunch, I would not expect you to give it up.  But, in a special instance of the ICU called needing a stat intubation and you happen to be the only one free and the rest of the staff are saying we are at lunch.  It’s an opportunity to show you are the ultimate team player.  

So much of the time I hear about that locum that always seems to run and hide.  They rarely complain about the rest of the staff that don’t eat in the break room or immediately leave the OR area just after a case and then people are calling and looking for them.  It does seem however that if the rental is missing for 5 minutes they can never find them.   At which point, I say that I had to pee but I am back at their service.  

Presence is also a knowledge presence.  You have to exude the fact that you are knowledgeable regarding the cases.   For example, oh at the last place we only used Isoflurane and we seemed to always use Milrinone.  I hear your CV surgeon doesn’t like Milrinone. What does your surgeon prefer and do you know the rationale?  I hear your total joint guys don’t use Tranexamic Acid, do you find you have higher EBL’s?  What percentage of retro/peri bulbar block need supplemental topical or why does your surgeon require so many blocks on basic cataracts?  I’ve seen complications of the blocks and wonder if your surgeons are newer or older?  One of our cataract surgeons doesn’t do their own blocks and isn’t comfortable with them.  They only use topical and in event of it not working on a prior eye, they ask anesthesia to do them.  

I also venture to state understanding the billing structure and pay ratios is important.  That presence is important in the negotiation of your contract.  If you know the group, agency or people will keep you busy and you know the payer mix is strong, then you know that you will be earning the group 2-5 times what you bill.  If that is the case then you should be able to negotiate a higher rate.  That is typically true unless you are in a high demand area.  CRNA’s are like anyone else, they will take advantage, undercut  the higher person in order to get the life they envision as best.  

So keep a good presence about you and keep your eye, ears and body aware.  



Skill and Presence are left in the things that make a good locum.  First... Can you believe I started this little site one month ago?  If I can do all this in a month, imagine what the future holds.  Well, honestly that means we are so very close to going back to work. It seems like I was just at work.  Tomorrow, marks another travel day in the life.  We will be flying back to Massachusetts from Kansas.  If anyone is in Worcester or wants to say hi in worcester we might be able to do the evening on the 30th of June.  I'll open it up on the FB page.  


I usually say something like... say what you mean and mean what you say.  This would be in the same category.  Know your skills and do them well.  You have to be able to do the cases the facility needs you to do.  So for each assignement I ask what typical cases are and that I'll be set in the rotation to do all the cases.  I love my A-lines and Central lines.  I love Pediatrics and neonatal cases.  I enjoy a good heart and major vascular case.  Neurosurgery for a tumor or a neuromonitoring back.  C-section for breach twins or an eclamptic that needs a stat section are all in a days work.  It's not uncommon for me to go in and find my schedule changed to something else because they added XYZ case.  It goes back to being flexible and they know I am. I have the flexibility because they know that in my pocket of skills and case-load I have the ability to do what they need.  They can take me out of the Total joint and put me into the emergency add-on trach.  They also know that I'll ask questions or make sure things are ok in the event something isn't right.  I'm not a cowboy and I'm not going to try and do what I'm not comfortable with.  

You have to develop the skills and types of cases over your career.  If you are a new grad, you're untested and an unknown quantity thus most places ask you to get a minimum amount of experience in a facility and I would say get a year or two at a semi-independent site.  Completely independent sites will normally do more bread and butter and dominating supervised practice can be so crippling to a career that it'd be better to go locum as a new grad.  So, I can't say what you should definitely be doing.  You should be capable of blocks, and basic a-lines and IV's, general cases, spinals and epidurals.   If not, when you start locums ... state this upfront to your recruiter or if independently contracting, you need to let them know.  Then you might want to learn.  If it is a long term assignment they may take a couple days to help you learn.  

Develop your skills and continue to give yourself variety so you can stay marketable.